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Prolonged Extrication as a Risk Factor for Pneumonia in Trauma Patients Involved in a Motor Vehicle Accident FREE TO VIEW

Doug Moore, MD; Lee Morrow, MD; Mark Malesker, PharmD
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Creighton University, Omaha, NE

Chest. 2013;144(4_MeetingAbstracts):379A. doi:10.1378/chest.1705215
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 10:45 AM - 11:45 AM

PURPOSE: Pneumonia occurs in up to a third of trauma patients with multisystem injuries. Although risk factors for pneumonia have been explored in motor vehicle accident (MVA) victims, the effect of prolonged extrication is unknown.

METHODS: In this single-center study we retrospectively reviewed the charts of all adult trauma victims who had activation of the emergency department (ED) trauma protocol. Patients who had been treated at another facility prior to arrival in our ED were excluded from the study. Abstracted variables included demographics, comorbid illnesses, trauma-related factors, microbiology data, and outcome measures. Multivariate logistic regression was used to identify variables associated with the development of microbiologically-confirmed pneumonia.

RESULTS: The study cohort included 1,523 consecutive MVA trauma patients of whom 243 (15.9%) developed microbiologically-confirmed pneumonia. There were 457 deaths (30.0%). Although univariate analysis confirmed several previously described pneumonia risk factors (lower Glasgow Coma Score [GCS], higher injury severity score [ISS], administration of blood products, acute alcohol intoxication, field airway), others were not significantly associated with pneumonia (age, obesity, immunosuppression). Multivariate logistic regression modeling identified variables independently associated with pneumonia in MVA victims including: reduced GCS (RR 1.05, p<0.001); acute alcohol intoxication (RR 1.63, p=0.02); prolonged extrication (RR 1.02, p<0.001); placement of an artificial airway in the field (RR 2.11, p=0.008); and comorbid structural lung disease (RR 1.17, p=0.04).

CONCLUSIONS: The risk of pneumonia in MVA trauma patients appears to be primarily increased by conditions that predispose to aspiration prior to arrival in the ED. Each minute of extrication time increases the relative risk of developing pneumonia by ~2%.

CLINICAL IMPLICATIONS: In order to improve clinical outcomes, additional studies are needed to delineate the mechanism(s) whereby prolonged extrication predisposes to pneumonia.

DISCLOSURE: The following authors have nothing to disclose: Doug Moore, Lee Morrow, Mark Malesker

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